Provider Demographics
NPI:1962642611
Name:FEDERAL CORRECTIONAL INSTITUTION ASHLAND
Entity Type:Organization
Organization Name:FEDERAL CORRECTIONAL INSTITUTION ASHLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-928-6414
Mailing Address - Street 1:PO BOX 888
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0888
Mailing Address - Country:US
Mailing Address - Phone:606-928-6414
Mailing Address - Fax:606-929-4392
Practice Address - Street 1:STATE ROUTE 716
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-0888
Practice Address - Country:US
Practice Address - Phone:606-928-6414
Practice Address - Fax:606-929-4392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service